The Mentored Research Scientist Development Award (K01) will provide the education and skills that I need to make the transition from clinically based randomized controlled trials and survey designs to population-based health services research. I am particularly concerned about assuring that high quality treatments with empirical support are in use in the public mental health system. This will require not only available evidence based treatments but the skills to adapt these treatments when necessary for effectiveness, dissemination, and implementation trials. Some disorders, such as depression in primary care, have benefitted from adaptation of evidence based efficacy treatments to meet the clinical needs of primary care patients and to fit into the primary care system. I am interested in expanding such research interventions to the treatment of parasuicidal behavior in the public sector. My long term goal is to develop a population-based allocation of mental health services for parasuicidal behavior within the public sector that is (a) guided by evidence based treatments, (b) implementable, given variable local system needs and structures, and (c) is cost-effective relative to usual care. To pursue this goal, I will need to expand my training in three areas: (1) clinical epidemiology and quality of care evaluation of usual care, (2) issues that facilitate or impede implementation of evidence based treatments in public mental health settings, and (3) health services research and design of population-based effectiveness studies. These goals reflect NIMH's recommendations of bridging science and service. The proposed study is a naturalistic epidemiologic follow-up of a sample of patients admitted to the psychiatric emergency department (ER) of a county hospital on a random-selection of assessment periods. Subjects will be assessed in the ER for parasuicidal behavior, psychiatric diagnosis, and service utilization for the previous 6 months. Subjects will then be re-interviewed 3 and 6 months following their ER admission regarding parasuicidal behavior and service utilization since admission. The goal is to identify the patterns and predictors of the course of parasuicide as it relates to utilization of treatment. The specific aims for the research study are as follows: 1) Determine subgroups of parasuicidal patients as defined by service utilization patterns and describe them based on clinical and diagnostic characteristics. 2) Evaluate quality of care for parasuicidal patients based on process indicators of mental health treatment quality. 3) Identify service utilization patterns related to system factors above and beyond patient factors (e.g., crisis services replacing outpatient as primary treatment for parasuicidal individuals).